Why we are acting to protect free and open communication with patients

Susan R. Bailey, MD , Past President

Physicians know that free, open and honest conversations with their patients are an essential and fundamental element of effective medical care. That is why our AMA has taken the extraordinary step of petitioning the U.S. Supreme Court to stop an unconscionable intrusion by the federal government that undermines the sanctity and privacy of the patient-physician relationship.

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The petition we filed Oct. 1 asks the nation’s highest court to review conflicting decisions by two federal appellate courts regarding a 2019 rule put forth by the Trump administration, which imposed drastic and harmful changes on the Title X family planning program. Our petition was joined by the Planned Parenthood Federation of America, the American Civil Liberties Union, the Oregon Medical Association and others.

The rule in question interferes with open communication between patients and health care professionals, which causes physicians and other clinicians to violate ethical obligations by prohibiting us from informing patients about all of their health care options. The 4th U.S. Circuit Court of Appeals invalidated the Title X rule, but the 9th U.S. Circuit Court of Appeals upheld it.

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Why the Supreme Court should take up Title X gag rule case

Our AMA believes the administration significantly overstepped its authority in issuing what is essentially a gag rule on physicians that directly harms patient care. Any action taken by government or any other third party to restrict or otherwise shape the content of that communication is a clear violation of patients’ rights under the AMA Code of Medical Ethics that also infringes on the First Amendment protections of physicians and other clinicians.  

Our AMA cannot allow this to happen. To that end, we have petitioned the U.S. Supreme Court for the first time in recent memory to correct the erroneous decision by the Ninth Circuit that threatens to decimate the Title X program.

Established 50 years ago, Title X provides health screenings, birth control and reproductive health services to people who could not otherwise afford this care, particularly low-income women. The program has saved millions of lives by providing access to breast and cervical cancer screenings, along with testing and treatment for HIV and sexually transmitted disease. In addition, the program’s effective support of family planning, and its emphasis on affordable and accessible birth control, have helped our nation achieve a 30-year low in the rate of unintended pregnancies, as well as sharp reductions in teen pregnancies and abortion procedures.

The implementation of the 2019 rule has been devastating. About one-fourth of all Title X providers have withdrawn their services from the program, endangering the health care provided to some 1.6 million patients across the country. Our petition notes that for six in 10 women who obtain contraceptive care at a Title X-funded site, that provider was their only source of medical care over the past year.

Changes to Title X resulting from the 2019 rule threaten to exacerbate health disparities tied to income, race, ethnicity, location and other demographic factors at the very time our nation is coming to grips with inequities in social justice in general, and in health care in particular.

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What you need to know about the Title X Rule

We must reject any attempt to inject political influence into the health care equation, and recognize the harm that results when the government seeks to place itself between patients and providers and limit the content of conversations between them. Imposing any restriction on the type of information physicians share with those they are working to heal impedes that mission and is antithetical to public health and sound medical practice.

Our AMA is committed to vigorously protecting every aspect of the physician-patient relationship because we recognize that it is a cornerstone of sound practice and good health. We have already witnessed the tremendous harm that results from outside interference with that relationship, which must not be allowed to continue.